Active NPI
Amy L Ennis, M.A, CCC-SLP
- Speech-Language Pathologist
- Lido Beach, NY
National Provider Identifier
1184820433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 58-016337
- Practice address
- 2 Richmond Rd
5K
Lido Beach, NY 11561-4845 - Phone
- (917) 549-3491
- NPI assigned
- Jun 25, 2007
- Last updated
- Jun 6, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 58-016337 | NY | Primary |
Addresses
Primary practice location
2 Richmond Rd
5K
Lido Beach, NY 11561-4845
Mailing address
2 Richmond Rd
5K
Lido Beach, NY 11561-4845
Phone (917) 549-3491
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58-016337 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307318400000",
"number": "1184820433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 RICHMOND RD",
"address_2": "5K",
"city": "LIDO BEACH",
"state": "NY",
"postal_code": "115614845",
"telephone_number": "917-549-3491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 RICHMOND RD",
"address_2": "5K",
"city": "LIDO BEACH",
"state": "NY",
"postal_code": "115614845",
"telephone_number": "917-549-3491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENNIS",
"first_name": "AMY",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "M.A, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-25",
"last_updated": "2011-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "58-016337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lido Beach, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.